accident and health

Question 1

provides periodic income weekly or at least monthly. income not taxable on individual policy

Answer 1

Disability income

Question 2

pays 66 2/3 of gross pay

Answer 2

disability income

Question 3

BOE policy

Answer 3

pays overhead, rent utilities

Question 4

buyout partner who becomes disables

Answer 4

Business disability buyout, for permanent disability

Question 5

principal sum

Answer 5

refers to the accidental death or death benefit

Question 6

capital sum

Answer 6

refers to the dismeberment

Question 7

limited benefits provided for daily hospital charges at a flat rate per day. pays first dollar (no deductible) days are limited

Answer 7

basic hospital insurance

Question 8

pays physician visits in hospital, flat dollar amount per day

Answer 8

basic medical insurance

Question 9

provides benefits for a surgeon in or out of hospital. flat amount for each operation.

Answer 9

basic surgical insurance

Question 10

pays high dollar amounts after the insured pays the deductible.

Answer 10

Major medical

Question 11

allows the insured to carry over expenses paid in 4th quarter of prior year to reduce current year deductible when no claims were paid to the insured

Answer 11

carry over provision

Question 12

% participation (80 20) insured and insurer share the cost after deductible

Answer 12

Coinsurance

Question 13

Limits the insureds liability to a certain dollar amount

Answer 13

out of pocket limit or stop loss provision

Question 14

Amount insured pays on major medical

Answer 14

deductible plus 20 percent of bill

Question 15

when the insured owns both basic and major medical

Answer 15

comprehensive, basic pays first then corridor deductible then major pays third

Question 16

imposed controls on use of health care services, fees charged for those services, providers of healthcare services

Answer 16

managed care

Question 17

health maintenance organization HMO

Answer 17

provides prepaid doctor and hospital care, stresses preventative medicine with exams and diagnostic procedures

Question 18

Requires employers with 25 or more employees ro offer HMO/PPO if there is a health plan or hmo in area

Answer 18

HMO act of 1973

Question 19

allows the insured the freedom of choice in selecting a health care professional non preferred provider

Answer 19

PPO

Question 20

This insurance always has a deductible

Answer 20

Major medical

Question 21

covers routine medical exams and diagnostic prodedures

Answer 21

HMO/PPO

Question 22

stresses preventive medicine

Answer 22

HMO/PPO

Question 23

pays first dollar coverage

Answer 23

Basic medical

Question 24

Small dollar amount that must be paid by this member with treatment

Answer 24

HMO/PPO

Question 25

coinsurance % participation

Answer 25

Major medical

Question 26

provides limited coverage

Answer 26

Basic

Question 27

gatekeeper PCP required

Answer 27

HMO/PPO

Question 28

managed care

Answer 28

HMO/PPO

Question 29

Pays directly to hospital and doctors

Answer 29

service organizations BC/BS

Question 30

pays directly to the insured

Answer 30

reimbursement insurer

Question 31

insured has choice of going in or out of network

Answer 31

point of service plan

Question 32

deduct money placed in a fund to pay medical expenses that were not reimbursed

Answer 32

MSA

Question 33

this account can be used to pay for expenses that are not covered by group health plans

Answer 33

Flexible spending account and HRA

Question 34

Must have 30 day free look

Answer 34

medicare supplement policies

Question 35

Must cover preexisting conditions after 6 months

Answer 35

medicare supplement policies

Question 36

Allows the insured to convert from group to individual without proving insurability (31 days)

Answer 36

group conversions

Question 37

provides better benefits at less cost

Answer 37

group

Question 38

all employers with 20 or more employees must provide continuation of group health insurance to all former employees and dependents

Answer 38

COBRA

Question 39

time allowed to choose cobra

Answer 39

60 days

Question 40

must provide coverage for at least 12 consecutive months

Answer 40

LTC

Question 41

must cover preexisting after 6 months

Answer 41

LTC

Question 42

must be at least guaranteed renewable

Answer 42

LTC

Question 43

includes entire contract, riders, endorsements and changes

Answer 43

entire contract

Question 44

time limit on certain defenses

Answer 44

2 years, except fraud

Question 45

additional time after due date

Answer 45

grace period 31 days

Question 46

getting back into force a lapsed policy

Answer 46

reinstatement

Question 47

if insurer fails to respond to the reinstatement form after _____ days, automatic reinstatement

Answer 47

45

Question 48

waiting period on reinstatement

Answer 48

10 days

Question 49

time required to file notice of claim

Answer 49

20 days

Question 50

must be sent to insured within 15 days

Answer 50

claim forms

Question 51

formal or sworn statement about loss

Answer 51

proof of loss

Question 52

time of payment of claims

Answer 52

immediately

Question 53

have ____ days to file suit against insurer after proof of loss

Answer 53

60

Question 54

this provision limits the time period that the insurer ay deny a claim based on prexisting conditions or misrepresentations

Answer 54

time limit for certain defenses

Question 55

provision that deals with the agent making revisions on the policy

Answer 55

entire contract - changes

Question 56

provision that states who will receive death benefits

Answer 56

payment of claims

Question 57

restricts the time for insured to file suit

Answer 57

legal actions

Question 58

provision allows the insurer at its expense to examine the insured when a claim is pending

Answer 58

physical exam and autopsy

Question 59

requires the insurer to mail forms within 15 days

Answer 59

claim forms

Question 60

companys promise to pay

Answer 60

insuring clause

Question 61

period of time after purchase before benefits are paid

Answer 61

probationary period (happens once)

Question 62

totally disabled from a covered accident or illness for _____ insurer waives premium

Answer 62

3 to 6 months

Question 63

refers to a condition that returns before the insured has been back to work for 6 months following total disability

Answer 63

recurrent

Question 64

insurer may cancel at any time

Answer 64

cancelable

Question 65

insurer may cancel on anniversary date

Answer 65

optionally renewable

Question 66

insurer may cancel based upon the conditions specified in policy

Answer 66

conditionally renewable

Question 67

insurer may not cancel but can raise premium on class basis

Answer 67

guaranteed renewable

Question 68

insurer may not cancel or raise

Answer 68

non cancelable

Question 69

when do you receive your first disability check

Answer 69

6 months

Question 70

provides periodic payments when unable to work

Answer 70

disability insurance

Question 71

time before benefits are payable after a covered accident or illness occurs is usually found in disability policies

Answer 71

elimination period

Question 72

provides funds to pay operating expenses of a business

Answer 72

business overhead insurance

Question 73

pays a monthly benefit to a business to cover additional help and pay an essential person while disabled

Answer 73

key employee

Question 74

pays the insured for loss of earnings after returning to work in the insured is unable to earn as much as before the total disability

Answer 74

residual disability

Question 75

refers to a disability where the insured is expected to recover

Answer 75

temporary

Question 76

inability to perform one or more but not all of the duties of the occupation (educated and trained for)

Answer 76

partial disability

Question 77

insurer would not require the insured to submit to periodic exams by their physician to prove continued disability

Answer 77

presumptive

Question 78

related disability relapse before being back to work for 6 months would be called

Answer 78

recurrent

Question 79

unable to work for rest of life

Answer 79

permanent

Question 80

inability to perform any of the duties required in occupation

Answer 80

total disability

Question 81

buyout of an owners interest if permanent disability occurs

Answer 81

key employee disability

Question 82

insurer wold not require the payment of premiums while totally disabled

Answer 82

waiver of premium